Home Health & Hospice Week
Outlier Payment Deficiencies Cripple Small Providers
Will the next claims system update fix the problem? Question: Is there anything we can do to help with the outlier payment issues that CMS is having? We have outlier payment deficiency on three clients now. We are well under the 10 percent threshold on payments. We are a small agency and these outlier payment issues are becoming crippling. Answer: The Centers for Medicare & Medicaid Services has been issuing system corrections since last October to try to rectify reimbursement problems related to its 10 percent cap on outlier payments. But so far none of the system updates has been effective. The outlier issue is a real problem for some agencies, says billing expert M. Aaron Little with BKD in Springfield, Mo. "We have ... clients in our billing services that are also very adversely impacted by this issue. But, on an overall basis it's such a small issue for CMS that there doesn't seem to be much of a rush to get it fixed." Another system fix is pending, HHH MAC Palmetto GBA confirms on its website. That fix is set for June 4, Little tells Eli. But "I don't know that [the update] will ultimately fix the root of the problem and result in freeing up the funds," he cautions. Consider this: "Depending on the agency's MAC, there may be a process by which they could request an advance/interim payment to be settled after the outlier fix," Little offers. "But that's probably a longshot." Until the problem is resolved, "if those outlier patients are still on service, they probably need to be looking for options for getting the patients off service by identifying an able and willing caregiver or other means," Little counsels.
Home Health & Hospice Week
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Outlier Payment Deficiencies Cripple Small Providers
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